[Neonatal RBC Transfusions]

Can anyone tell me if their standard practice for neonatal RBC transfusions is to provide WASHED PRBC's (in addition to CMV (-) and irradiated product), and if so, do you wash the cells in-house or does your local Blood Center provide the washed units?

We do not wash the RBCs. We do use CMV negative and irradiated units. One of the main reasons for washing RBCs would be to decrease the amount of potassium in the unit. We ensure the potassium is low by using the freshest unit available (always less than 7 days, usually 2-4 days).

[TEG testing]

We have been using the TEG at our facility for probably 10 years now. It has dramatically reduced the blood product usage on open heart cases. It is operated by a perfusionist in the OR. We have always wanted to duplicate the instrument in the Lab but that has not happened yet. Other surgical areas have studied the usefulness of this instument in their areas but it has not really taken off very well into any area other than OHS. (Mostly because they are unscheduled and the Perfusionist needs to be there to run the instrument)

Matter of fact we had a really bad week in June a few years ago with tons of product going out. We couldn't figure out what was going on. Then later found out that the TEG had been out of service that week. (The lab is the last to know!) I swear by the TEG. We did many studies on the usefulness of the TEG back in 2001-2002. That was when we were trying to get a second unit in. The studies looked great but the second unit never has appeared! Some of the key points to it are that the physician has to trust the person reading the results! And then also the person interpreting the results needs to be well trained! The interpretation tells you exactly what products to give the patient or if there is still a bleeder that needs to be repaired. Personal opinion - for the patient's sake I think this instument is awesome!

We are also looking at using the TEG for CV surgery, and trauma. Is one instrument enough? We were told for platelet mapping you need 2 analyzers (4 channels). At your institution do they do platelet mapping (pre-op to look for platelet inhibition) in addition to the rapid TEG (intra and post-op)?

[Emergency Transfusion O pos or O neg?]

Thanks everyone,

However, my original question was regarding references that my manager wants us to have as ammunition. Know of any?

By the way, my most tenacious tech was working that night and did her best to follow protocol and use O pos. We are now on emergency level of O neg in our region and I sure would like to have the 2 O negs back that we gave. My approval is needed to release any O neg for transfusion.

To quote Dr. John Hess of Baltimore Shock Trauma (2nd article below), "trauma tends to be a guy thing."

A brief PubMed search yielded 2 articles on the topic. There may be more.

Surg Gynecol Obstet. 1988 Sep;167(3):229-33.

Use of Rh positive blood in emergency situations.

Schmidt PJ, Leparc GF, Samia CT.

Service Laboratories, Southwest Florida Blood Bank, Tampa.

The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.

J Trauma. 2005 Dec;59(6):1445-9.

Safety of uncrossmatched type-O red cells for resuscitation from hemorrhagic shock.

Dutton RP, Shih D, Edelman BB, Hess J, Scalea TM.

R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. rdutton@umaryland.edu

BACKGROUND: Uncrossmatched type-O packed red blood cells (UORBC) are recommended for immediate transfusion in hemorrhaging trauma patients. The potential for alloimmunization with this technique is controversial, and has been reported to be as high as 80%. We examined a 1-year experience with UORBC transfusion to determine the incidence of allergic reaction and alloimmunization. METHODS: Blood Bank and Trauma Registry databases for the year 2000 were linked to determine the incidence of UORBC use and the characteristics of patients, including the incidence of transfusion reactions and seroconversion of Rh-patients. Ten units of type-O, Rh+ blood (and two units of O-blood for women of childbearing age) were available for immediate transfusion, 30 to 45 minutes sooner than type-specific or crossmatched red blood cells. UORBC were administered to any patient with signs of severe hemorrhagic shock, at the discretion of the attending physician. RESULTS: In all, 480 trauma patients (out of 5,623 admitted) received transfusions of RBC, totaling 5,203 units. Five hundred eighty-one units of UORBC were given to 161 patients. Average Injury Severity Score in the UORBC cohort was 33.8. Patients receiving UORBC received an average of 16.9 total units of red blood cells, 14 units of plasma, and 10 units of platelets. Seventy-three patients died (45%). There were no acute hemolytic transfusion reactions observed in the patients who received UORBC. Four Rh-women received UORBC, all O-. Ten Rh-men received O+ blood, and only one developed antibodies to the Rh antigen. CONCLUSION: The need for UORBC is associated with significant injury and the need for subsequent massive transfusion. In this largest reported trauma series, the use of UORBC enabled rapid administration of red cells to hemorrhaging patients, without discernible risk for transfusion-related complications. The rate of seroconversion of Rh-patients is lower than reported in the literature, perhaps due to immune suppression associated with hemorrhagic shock.

[PANDAS and plasmapheresis]

Does anyone have experience or data regarding plasmapheresis on PANDAS patients? The literature (what there is) is promising. Any information and resources are appreciated. Thank you!

I have not seen a patient with this, but the literature does look promising. In all the articles I found on Pub Med, it helped. In one article the patient's tics/OCD symptoms were so severe they had to do plasmapheresis under general anesthesia the first few times, but it worked and symptoms improved.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - anesthetic implications and literature review.

Sadhasivam S, Litman RS.

Paediatr Anaesth. 2006 May;16(5):573-7.